In this teaching session for medical students preparing for their final OSCE exam, the focus will be on data interpretation for musculoskeletal (MSK) X-rays. Participants will learn how to analyse and interpret results from these imaging modalities, emphasizing the identification of key findings, understanding relevant anatomy, and correlating results with clinical scenarios. The session will cover common conditions associated with abnormal findings in MSK imaging, facilitating a comprehensive understanding of musculoskeletal pathophysiology. Through interactive discussions and case studies, students will enhance their diagnostic skills and clinical reasoning. The session will conclude with a summary of important concepts and a Q&A segment to address any questions from participants.
MSK x-ray interpretation
Summary
Dr. Ronan Fitzgerald will conduct an insightful on-demand teaching session on the interpretation of Musculoskeletal (MSK) X-rays geared toward medical professionals. The session covers how to correctly recognize and interpret different types of MSK X-rays, identify common abnormalities, and apply the general steps of hand X-ray interpretation.
Medical professionals attending the session will deepen their understanding of radiograph details such as the type of film, body parts involved, and adequacy. They will also learn how to systematically interpret X-rays using the ABCS—Alignment, Bone, Cartilage, and Soft Tissue.
The course extends to recognizing changes in alignment like subluxations, dislocations, and fractures; tracing the cortex to indicate a fracture and identifying the location, type, and direction of the fracture. The session will also cover various aspects related to cartilage assessment such as joint spaces, disruption of joint contours, and signs of specific types of arthritis.
Everyone attending will also explore soft tissue analysis which includes identifying soft tissue swelling, joint effusion, evidence of emphysema, foreign bodies, and any surgical or medical apparatus. Medical professionals will surely find this session impactful and integral to their work in healthcare.
Description
Learning objectives
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Understand the principles of MSK X-ray interpretation including the steps in reviewing a film (patient details, radiograph details, prior examinations, interpretation through ABCS alignment, bones, cartilage, soft tissue).
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Accurately recognize common abnormalities reflected in MSK X-rays, including discerning disruptions in alignment which may occur from subluxation, dislocation or fracture and abnormalities on the cortex.
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Practice identifying and describing fractures using the 3W’s: where the fracture is, what type of fracture there is, and where the bone is displaced.
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Gain knowledge of the anatomical structures visible in a hand X-ray and learn how to apply general steps of hand X-ray interpretation following the above stated principles.
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Develop an understanding of how to systematically follow patterns to identify any changes in alignment, bone structure, cartilage and soft tissue in the hand, to differentiate normal from abnormal results, and diagnose various conditions.
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MSK X-RAY INTERPRETATION By Dr Ronan Fitzgerald Learning outcomes 1 2 3 4 Recognise the steps in how to Identify common abnormalities Identify the anatomical Apply the general steps of generalet MSK X-rays in that MSK X-rays can have structures on a hand X-ray hand X-ray interpretationfor MSK X-RAY INTERPRETATION FORMAT Radiograph details: • Type of film (AP/oblique etc.) Confirm patient details, date • If only 1 film state you would prefer of X-ray, and compare to another film to compare. previous films. • Which body part: (body part + side of the body (left or right). • Adequacy (RiPE): Rotation, Penetration, Exposure Interpretation (ABCS) • Alignment State any obvious • Bone abnormalities and then go • Cartilage through X-ray systematically • Soft tissue ABCS; ALIGNMENT Change in alignment: Subluxation, dislocation or fracture. Dislocation=no joint-joint contact Subluxation=partial joint-joint contact Describing displacement: Describe the position of the distal fragment.-White and red lines show joint surfaces. -There is complete dislocation. -We can see the benefit of 2 views here.-Displacement of the distal fragment -Preserved joint-joint contact -Subluxation nd -However, 2 view needs obtainingAP viewOblique view ABCS; BONES Trace around the cortex: any disruption to the cortex could indicate a fracture. Describe the fracture (the 3W’s) DESCRIBING FRACTURES 3 W’S Where is Where is the What type the bone fracture? of fracture? going? WHERE (IS THE FRACTURE) Which bone? Where on the bone: Proximal/middle/distal third Does it involve the joint as well: (intraarticular or extraarticular) WHAT (TYPE OF FRACTURE IS IT) Completeness (complete/incomplete) Direction (transvere, oblique, spiral) Are they any separated pieces of bone (comminuted, segmental e.t.c.)Complete-Bone has cortical disruption on both sides of the bone and the fracture extends the whole width of the bone Transverse: fracture occurs at horizontal plane to axis of bone (at a right angle) Spiral: fracture caused by twisting injury Oblique: fracture at an angle to the shaft Comminuted: More than 2 detached bone fragments Segmental: Multiple complete fractures creating an isolated bone fragment Impacted: break ends are compressed together Greenstick: Incomplete fracture of the bone resulting in bending of the bone (seen in children)GREENSTICK FRACTURE WHERE (IS THE BONE GOING) Is the bone % of bony being contact displaced? remaining ABCS; CARTILAGE Joint spaces: assess for loss of joint space or joint widening Disruption of joint contours Signs of Osteo/rheumatoid/psoriatic arthritis or gout/pseudogout ABCS: SOFT TISSUE Soft tissue swellings Joint effusion Evidence of emphysema Foreign bodies Surgical or medical apparatus in situ· Arrows indicate effusion in the knee · The effusion is displacing the patella anteriorly· Red arrow=lipohaemarthrosis · Blue arrow= tibial plateau fractureSURGICAL EMPHYSEMAWRIST X-RAYS: ANATOMYPA VIEWLATERAL VIEWOBLIQUE VIEW ALIGNMENT-AP VIEW Assess the distal radius articular surface’s position: should be cupping the carpal bones Assess carpal arcs (also called gilulas lines): any disruption to an arc could suggest fracture or ligamentous injuries Capitate bone looks like a toothpaste ‘cap’ ALIGNMENT-LATERAL VIEW Normal findings: • The long axis of the radius, lunate, capitate, and third metacarpal should align. Lunate bone looks like a lunar eclipse moonCups of tea sign Spilled teacupVOLAR TILT (ONLY FOR INTEREST) Volar tilt, or palmar tilt, is an important measurement in the evaluation of distal radius fractures and radial deformities. The volar tilt is assessed on the lateral radiograph of the wrist, it corresponds to the angle formed by a line drawn perpendicular to the axis of the radial shaft, and a line that passes through the tips of the dorsal and volar rims (i.e. along the radius articular surface) Normal is 7-15 degrees BONES Radius: assess to ensure no distal or proximal fractures Ulnar styloid Carpal bones: pay careful attention to the proximal row and the scaphoid as these are most commonly injured **Scaphoid is particularly at risk of avascular necrosis Metacarpals · Spaces between carpal bones is CARTILAGE normally 1-2mm: any increase/decrease in space could be indicative of pathology SOFT TISSUES · Generally, assess soft tissue structures of the wristSpot diagnoses COLLES FRACTURE FOOSH Fracture at distal end of radius Dorsal displacement of distal fragment Dinner fork deformity Smiths fracture FOOSH (backward falling**) Fracture at distal end of radius Palmar (volar) displacement) of distal fragment ‘Reverse of Colles fracture’ BARTONS FRACTURE Intraarticular distal radius fractureThank you for listening any questions